Details of the WATCH-TAVR trial

The WATCH-TAVR trial’s primary endpoint was a composite of all-cause mortality, stroke, and major/life-threatening bleeding over a two-year period.

Results of the trial revealed that the combined procedure was noninferior to TAVR alone. The rates of adverse events, including mortality, hospital stays, and contrast nephropathy, were not higher in patients who underwent the simultaneous procedures. 

Through two years, the primary endpoint of all-cause mortality, stroke or major/life-threatening bleeding was 33.9% in patients treated with the combined procedure and 37.2% in those treated with TAVR alone, a difference that met criteria for noninferiority with a P < 0.001. The trial did not show superiority.

Reducing healthcare costs with combined procedures

As we move toward a more patient-centric and cost-effective healthcare system, the results of this trial could become a crucial building block for future advancements in cardiovascular procedures.

Combining LAAO with TAVR offers several advantages, including potential cost savings. By performing both procedures in a single session, the need for additional resources, such as catheters and access points, is minimized, leading to reduced costs. Furthermore, patients avoid the expenses associated with a second hospital admission.

The WATCH-TAVR trial’s success has the potential to reshape the landscape of cardiac procedures, emphasizing the advantages of combining different interventions in a single session. Kapadia and his team are actively discussing with Centers for Medicare and Medicaid Services (CMS) the possibility of creating a combined reimbursement code that reflects the value of this approach. They have been receptive to the idea, he said.

Even if it results in slightly reduced payments for the procedures, this strategic shift in patient care may pave the way for future trials. It opens up new possibilities for combining other complementary procedures.

Kapadia believes there will be a big push in the next few years to combine more procedures into one-stop-shops for patients to boost cardiology department efficiency, patient satisfaction and even outcomes.

“AFib ablation and Watchmen are happening together, and Watchman may happen together with CardioMEMS. So there are so many things that are complimentary in the same patients and this trial shows that we can do it relatively safely together. I think there is a good chance that we can potentially make this a reality,” Kapadia explained.